Provider First Line Business Practice Location Address:
149 ST.NICHOLAS AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-246-9166
Provider Business Practice Location Address Fax Number:
718-715-1302
Provider Enumeration Date:
04/22/2008